Khan Atif N, Sabbagh Salah, Ittaman Sunitha, Abrich Victor, Narayan Aarti, Austin Bryan, Rezkalla Shereif H
Department of Cardiology, Marshfield Clinic, Marshfield, Wisconsin.
J Interv Cardiol. 2015 Feb;28(1):14-23. doi: 10.1111/joic.12177. Epub 2015 Feb 9.
To compare morbidity and mortality of patients with ST-elevation myocardial infarction (MI) undergoing coronary artery bypass graft (CABG) surgery within 24 hours with those who had surgery delayed >24 hours.
Patients with ST-elevation MI are currently managed by emergency percutaneous coronary intervention (PCI). If PCI is unsuccessful, or if there is severe coronary artery disease not amenable to PCI, CABG is considered. If the patient is clinically stable, surgeons wait several days before performing surgery, as very early surgery carries a prohibitive risk.
One hundred and eighty-four patients with acute ST elevation MI (STEMI) who had undergone CABG were divided into two groups based on their surgery timing (<24 hours vs. >24 hours). Mortality and complication rates were studied between the two groups by Fischer test. Time-to-event analyses were performed for five primary variables: all-cause mortality, cardiac events, congestive heart failure, stroke, and renal failure.
At one month post-CABC, all-cause mortality was noted in 10.6% of patients who had CABG within 24 hours of STEMI diagnosis, compared with 8.9% in patients who had CABG after 24 hours (P = 0.3). Cardiac events including re-exploration, atrial fibrillation, graft occlusion, and arrhythmias requiring shock occurred in 17.1% versus 13.9% between the two groups, respectively (P = 0.68). One year post-coronary artery bypass surgery, there was no difference in individual or combined events between the two groups.
In patients with ST-elevation myocardial infarction who required emergency coronary artery bypass surgery, there was no difference in procedure complications or mortality between early (within 24 hours) or later (more than 24 hours). That was noted at one month and one year after the index myocardial infarction.
比较在24小时内接受冠状动脉搭桥术（CABG）的ST段抬高型心肌梗死（MI）患者与手术延迟超过24小时的患者的发病率和死亡率。
ST段抬高型MI患者目前通过紧急经皮冠状动脉介入治疗（PCI）进行管理。如果PCI不成功，或者存在不适合PCI的严重冠状动脉疾病，则考虑进行CABG。如果患者临床稳定，外科医生会等待几天再进行手术，因为极早期手术风险过高。
184例接受CABG的急性ST段抬高型心肌梗死（STEMI）患者根据手术时间（<24小时与>24小时）分为两组。通过费舍尔检验研究两组之间的死亡率和并发症发生率。对五个主要变量进行事件发生时间分析：全因死亡率、心脏事件、充血性心力衰竭、中风和肾衰竭。
在CABC术后1个月，STEMI诊断后24小时内接受CABG的患者中全因死亡率为10.6%，而24小时后接受CABG的患者中为8.9%（P = 0.3）。两组中心脏事件（包括再次探查、心房颤动、移植物闭塞和需要电击的心律失常）分别为17.1%和13.9%（P = 0.68）。冠状动脉搭桥术后1年，两组之间的个体或合并事件无差异。
在需要紧急冠状动脉搭桥手术的ST段抬高型心肌梗死患者中，早期（24小时内）或晚期（超过24小时）手术在手术并发症或死亡率方面没有差异。这在首次心肌梗死后1个月和1年时观察到。
